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Symposia Application/Guidelines Request Form

Note: Items marked with * are required.

*Name:
*Title:
*Company Name:
*Address:
Address 2:
*City:
*State:
*Zip:
*Country:
Phone:
Fax:
*E-mail:
  

How did you hear about the ACP annual meeting?

Past Exhibitor
Email Advertisement
Colleague
Direct Mail
Other
If Other:
  

Please add me to your mailing list so I can receive future updates:

Yes
No
  

Symposia Dates

April 17 - 21
New Orleans, LA

Deadline: November 23, 2011
ACP will continue to accept applications if all time slots are not filled at the time of the initial deadline.

Administrative Fee

CME Non-CME
Breakfast $36,000 $25,000
Lunch $50,000* $50,000*
Dinner $36,000 $25,000

* $50,000 includes meeting room rental fee.

The administrative fee includes the promotion of the symposia as outlined on page 5 in the Industry Supported Symposia Application and Guidelines[PDF]. All other expenses are the responsibility of the supporting company.